Ashley Copeland talks to her mother in the Swedish Medical Center ED. Copeland was treated for a severe headache with a nerve-blocking anesthetic, but no opioids. (John Daley/CPR News)

Last year, in an effort to address the state’s acute opioid abuse problem, several Colorado health care organizations—including the Colorado Emergency Nurses Association—worked together on an intervention to target patients admitted to the ED with pain. The plan? Implement a pain management program to promote alternative strategies, with a goal of decreasing opioid usage by 15% in the participating EDs.

As discussed in a June news article, the program, which was piloted in 10 hospitals and involved heavy involvement from nurses, surpassed its goal: opioid usage during the intervention period (as measured in morphine equivalent units) was 36% less than in the previous year.

The pilot project targeted patients with the following types of pain:

  • musculoskeletal pain
  • chronic abdominal pain
  • pain associated with migraine and other headaches, kidney stones, and arm and leg fractures and dislocations

In accordance with the Colorado American College of Emergency Physicians 2017 Opioid Prescribing and Treatment Guidelines—which urge the adoption of alternatives to opioids for pain treatment—the program introduced new medications and procedures to treat pain and provided guidance for using opioid alternatives. These included acetaminophen, ibuprofen, lidocaine, haloperidol, ketamine, ketorolac, and dicyclomine.

Given its results in reducing opioid prescribing, the program is now expanding throughout Colorado, with 50 more hospital EDs set to receive training. While most patients treated with short-term opioids for acute pain are not at high risk for addiction, a multimodal approach to pain management will help those who are and, if used appropriately, may also improve pain management for all patients.

Let us know your perspectives on changing opioid prescribing practices in emergency departments.